Drug shortages have forced St. Albert pharmacies to alter patients’ prescriptions and triage access to some medications.
Two drugs are in particularly short supply across the country: the painkiller medication Tylenol 4 and the diabetes and weight-loss drug Ozempic.
“It’s been excessively challenging,” said Nicole Schettler, owner of Nicole’s Pharmacy.
“The good news with Tylenol 4 is there are other things we can do. But with Ozempic, it's not easy to come up with a replacement. I’ve got a list of around 20 people who I’m trying to triage.”
Patients using injection Ozempic for diabetes take priority, Schettler said. She has been prescribing Ozempic in oral tablet form -— which she said is not as well-tolerated as the injection — and diabetes drug Mounjaro for patients who need a weight loss medication replacement.
But Schettler said the shortages of Ozempic and Tylenol 4 are “just the tip of the iceberg.”
Sometimes she sends an order and doesn’t receive half the items she requested.
Items such as acne medication and certain mouthwashes disappear from her shelves, and she has trouble getting them back in stock.
Schettler said the shortages are “at least as bad, if not worse” than at the height of the COVID-19 pandemic or in the period immediately after. Last year’s shortages of over-the-counter medications such as kids’ Advil were just “the canary in the coalmine,” she said.
For patients who regularly use Tylenol 4, Schettler has been prescribing an alternative medication that contains both codeine and acetaminophen to go along with an extra codeine tablet. Together the drugs are as powerful as a single Tylenol 4.
But Schettler is concerned that the replacement medications leave “room for error,” especially for some seniors who have been taking one or two Tylenol 4 pills a day for many years.
“It’s really stressful,” she said.
Tana Macnab has prescriptions for both Tylenol 4, which she has used for many years to manage pain, and Ozempic, which she used for weight loss.
She lives in Edmonton but gets her medications from Grandin Prescription Centre, where she’s been going since 1994.
The combination of regular Tylenol and codeine tablets she has been prescribed as a replacement for Tylenol 4 makes her nauseated and dizzy. Although the mixture is similar to Tylenol 4, Macnab still hasn’t found the right ratio of codeine tablets to take to avoid the side-effects, whereas she could reliably take Tylenol 4 once or twice a day.
“If I’ve got a busy day and I have to do a lot, then my pain is going to be worse,” she said. “[Right now] I don’t have the confidence to know that I can take something and be more comfortable … I’m kind of afraid to.”
Macnab stopped taking Ozempic once she learned about the shortages.
“I didn’t want to be taking it away from people who are using it for diabetes,” she said.
According to the Drug Shortages Canada website (www.drugshortagescanada.ca,), Teva Canada, which manufactures Lenoltec No. 4, a common generic version of Tylenol 4, is experiencing shortages because of a manufacturing disruption. They expect the problem to be over by Jan. 10, 2024
Purdue Pharma is also short on its 50-milligram codeine tablets and expects to be back to normal by Jan. 5, 2024.
Novo Nordisk, the company that makes Ozempic, initially reported that the Ozempic shortage would end in October, but now they predict some of their products will be shorted until March 2024.
In an email to the Gazette, Health Canada said it is “actively looking into these shortage reports to determine (the) impact on the Canadian health care system and patient access.”
“Health Canada continues to monitor all possible shortage signals and will not hesitate to take action, as necessary.”